The American Society for Microbiology (ASM) is pleased to provide a written statement on the Fiscal Year 2001 appropriation for the Centers for Disease Control and Prevention (CDC). The ASM is the largest single life science society in the world with more than 42,000 members representing a broad spectrum of subspecialties, including microbiologists who work in clinical, public health, biomedical and industrial laboratories. The ASM appreciates the Subcommittee's ongoing support of the CDC, particularly for the CDC's National Center for Infectious Diseases (NCID), which funds programs, addressed in this statement, related to emerging and drug resistant infectious diseases, public health infrastructure, bioterrorism preparedness and food safety.

The ASM endorses the recommendation of the CDC Coalition to increase the overall CDC budget to a level of $4.1 billion, an amount that exceeds the President's budget request by approximately $600 million. The CDC requires additional new resources to respond to an array of continuing and new public health challenges. As the "Nation's Prevention Agency," the CDC is charged with promoting health and quality of life by anticipating, identifying, preventing and controlling diseases and other public health threats. The CDC must have adequate resources to expect and be prepared for unexpected public health emergencies throughout the country and across the globe, including, for example, a bioterrorism event, a global influenza pandemic, a large scale environmental disease threat or an unforeseen public health danger.

In the following statement, the ASM will focus on specific areas within the CDC budget which are of concern to the microbiological community.

The American people benefit from a well-funded and effective federal health system. In the past year, the rapid response by health officials identified an outbreak of West Nile encephalitis in New York, Connecticut and New Jersey; linked E. coli O157:H7 infection at an upstate New York county fair to contaminated water; and tied a multi-state outbreak of Listeria infections to contaminated hotdogs and cold-cut meats manufactured at a single plant. These successes are due to state-of-the-art molecular laboratory diagnostic tools, as well as to coordinated communications and disease reporting systems among health agencies. Initiated in 1995 by the CDC, the Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreements are helping to rebuild the nation's public health infrastructure at state and local levels, and making possible success against infectious disease outbreaks. In FY 1999 CDC awarded more than $40 million to all states and four cities to boost preparedness against possible chemical and biological terrorism, and developed laboratory protocols for several of the possible bioterrorism agents to share with state and local laboratories. In 1999 the CDC also distributed nearly 300,000 copies of recommendations for prevention and control of hepatitis C infection (HCV) infection and HCV-related liver disease to physicians and health care providers nationwide.

The ASM recognizes and applauds the breadth of the CDC's contributions to these and other successful public health campaigns. Despite positive past experiences, however, the vigilance needed against disease will only intensify as we move through the 21st century. The blood-borne hepatitis C virus, for example, has infected more than 4 million persons in the United States, 3 million of whom remain chronically infected and therefore at risk for developing cirrhosis or liver cancer. In this country each year, 8000 to 10000 die from cirrhosis or primary liver cancer. The CDC is coordinating the Hepatitis C Public Information Campaign, aimed toward notifying all prior transfusion recipients at risk for HIV infection. It will continue ongoing investigations into various risk factors and modes of transmission, as well as collaborate with other groups like the American Liver Foundation to educate the public about HCV. Sufficient funding would strengthen and expand this multipronged effort against HCV infection. Like the hepatitis viruses, both "old" and newly emerging or reemerging infectious diseases will continue to challenge our society's well-being and productivity, and thus make even more imperative an adequately funded federal public health agency.

The CDC is recognized the world over for its efforts to combat the threats of new, emerging and drug resistant infectious diseases. Infectious diseases are a crisis of global proportions which threaten gains in health and life expectancy and which are now the world's biggest killer of children and young adults. Substantial new funding is needed to enable CDC to fully implement its comprehensive plan, "Preventing Infectious Diseases: A Strategy for the 21st Century." The additional $25 million requested for this initiative in the Administration's FY 2001 budget would not provide adequate resources needed to fully implement the next phase of the plan. The ASM concurs with other supporters of the CDC that an additional $162 million would achieve in the appropriate time frame the CDC goals set forth in 1998 for emerging infections. These goals include a broad range of improvements to such critical functions as detection and prevention of emerging pathogens, communication among all levels of government health agencies, and integration of laboratory science with on-site epidemiology.

Also targeted in the 1998 plan was the alarming trend toward antimicrobial resistance among pathogenic microorganisms. Approximately 28 percent of bacteria that cause hospital-acquired infections in the United States, for example, are resistant to the specific antibiotic once considered most effective against that particular infection. Especially problematic is the reduced susceptibility of Staphylococcusaureus to vancomycin. The CDC has specific plans to address this problem which will require sufficient funding: improved clinical guidelines for antibiotic usage; better public education on the issue of overuse of antibiotics; research on antibiotic resistance genetic markers as monitoring devices; and a national surveillance system to assess the overall impact of antibiotic resistance.

Public Health Infrastructure

The ASM recommends that Congress increase the budget requested to modernize the CDC's outmoded, severely inadequate and deteriorating physical plant. CDC needs funding and authority to modernize existing laboratory and support facilities and construct new facilities according to its long range facilities master plan which addresses building and facilities needs through the year 2009. Almost all of CDC's laboratory capacity is currently dangerously antiquated, unsafe and unsuitable for modern scientific research activities related to CDC's public health role. CDC has experienced substantial program growth in recent years, and facilities have not kept pace with new programs created in response to an increasing number of dangerous threats from deadly pathogens. The ASM recommends that Congress provide at least the $127 million requested (an additional $70 million over FY 2000) for CDC infrastructure needs and consider providing an even higher level of $175 million to fully meet the facilities needs and repairs at CDC and accelerate planned construction and upgrades.

Bioterrorism Preparedness and Response

The CDC has established a national effort to protect the public's health in the event of a biological or chemical terrorist attack. The initiative builds on the efforts begun at CDC in FY 1999 that focused on building core capacity within CDC and in states to establish clinical laboratory surveillance, information technology and epidemiologic expertise for the highest probability agents. The ASM notes that funding for CDC bioterrorism preparedness activities decreases by $6.5 million to a level of $148.5 million in the Administration's budget request. Current funding levels permit only partial implementation of this program, leaving many states and cities with limited or no coverage in some key preparedness areas. Additional funding would allow more state and local health departments to build capacity in essential areas of biological and chemical preparedness including: planing, surveillance and epidemiology, biological and chemical laboratory services and electronic communication.

A recent Institute of Medicine report on "Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response," stresses the need for long-term public health infrastructure improvements. Bioterrorism preparedness is also a part of CDC's larger effort to reinvest in the public health system to establish capability to respond to naturally occurring infectious disease threats. The ASM supports the requested $2 million for CDC deterrence efforts to monitor laboratory compliance with the Antiterrorism and Effective Death Penalty Act of 1996 and to ensure the safe handling of potential threat agents in diagnostic and research laboratories.

Foodborne and Waterborne Diseases

While often not as dramatic as a newly identified infection, foodborne and waterborne disease outbreaks in recent years have been sudden and deadly. The CDC rightly has not neglected this ever-present threat to the American public. In collaboration with the FDA and USDA, the CDC has revitalized measures against further outbreaks caused by contaminated food and water supplies. For example, the CDC PulseNet program, now in more than 30 states, enables local health departments to rapidly identify the microbial agents responsible for an outbreak, by utilizing modern molecular fingerprinting technologies. Rapid response is essential in such outbreaks, as spread of infection can occur if the food or water source is not quickly identified and removed. Foodborne diseases alone are estimated to cause 5,000 deaths and 76 million illnesses in the United States yearly. Therefore, the ASM recommends approval of the Administration's proposed increase of $10 million for foodborne diseases as part of the CDC budget for infectious diseases in FY 2001.

Cost Effective Strategy

An investment today in the CDC is an investment in tomorrow's public health. Finding our way safely through the maze of public health problems often seems costly, but the collective price tag of infectious disease in death, illness, and dollars is alarming. For instance, hospital-acquired infections kill 88,000 people annually in United States and cost more than $4.5 billion each year. Public health officials estimate that foodborne illness costs this nation's economy several billion dollars annually. Just in this country, the influenza pandemics of 1957-58 and 1968-69 created combined economic losses of about $32 billion (1995 dollars).

Monetary savings, of course, are not the only reward from a strong, innovative, and forward-looking public health system in the United States. More importantly, the American public rightly receives physical and emotional benefits from its long-standing support of medical and scientific research. Those benefits may be direct and obvious, such as identification of contaminated water supplies, or less obvious but equally important, as in the case of a strengthened infrastructure for public health to develop and share health-related technologies and information among health agencies. A reinvigorated public health system with effective programs will help protect the public against existing and emerging threats, such as antimicrobial resistance, chronic diseases with infectious origins and pandemic influenza.

Thank you for the opportunity to provide a written statement for the hearing record on the CDC's FY 2001 appropriations.